Program Policy Medicaid Modernization Lead

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Functional Title: Program Policy Medicaid Modernization Lead
Job Title: Program Specialist V
Agency: Health & Human Services Comm
Department: Program Policy Spec A
Posting Number: 11089
Closing Date: 11/24/2025
Posting Audience: Internal and External
Occupational Category: Community and Social Services
Salary Group: TEXAS-B-21
Salary Range: $4,523.16 - $7,253.83
Pay Frequency: Monthly
Shift: Day
Additional Shift: Days (First)
Telework:
Travel: Up to 5%
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Nonexempt
Facility Location:
Job Location City: AUSTIN
Job Location Address: 701 W 51ST ST
Other Locations: Austin
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS

Brief Job Description:

The Program Policy team within the Medicaid and CHIP Services (MCS) Office of Policy is seeking a Program Specialist V who will serve as the Program Policy Medicaid modernization lead. Medicaid modernization is an agency-wide project to streamline and update the highly complex network of interconnected systems that support Texas’ Medicaid delivery system. This position will have specialized knowledge in medical billing and coding and serve as the managed care policy liaison between Program Policy and MCS Operations, HHSC Information Technology, and technology vendors. Additionally, this position will serve as the lead analyst on managed care policy questions and projects related to medical benefits and billing processes.

This position performs advanced consultative and technical work related to the planning, developing, implementing, and maintaining new technology contracts, and amending existing technology contracts to implement Medicaid modernization efforts. This includes a range of responsibilities including:

• Coordinates and collaborates with internal and external stakeholders to create and update policies, procedures, contract requirements, administrative rules, business rules, and communications to external stakeholders and contractors.
• Develops project timelines for assigned projects, monitors and reports on progress, and updates timelines as necessary.
• Coordinates and collaborates with the internal and external stakeholders to schedule standing meetings, respond to policy inquiries, draft reports, update content in public documents and websites, and manage shared mailboxes.
• Assists in researching managed care organizations’ compliance with program policy contractual requirements.
• Participates in and helps to facilitate meetings with stakeholders, including managed care organizations, provider associations, people receiving services, and subject matter experts.

This position reports to a Manager for Program Policy in the Medicaid and CHIP Services Division. This position works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

Essential Job Functions (EJFs):

Collaborates with other areas of MCS and HHSC to plan, develop, implement, monitor, interpret and evaluate Medicaid programs, policies, MCO contract requirements, business rules, administrative rules, waivers, and state plan. Evaluates MCO compliance with program policies and procedures, contract requirements, statutes, and rules and takes corrective action if needed. (25%)

Plans, monitors, and evaluates MCS implementation of state legislation, federal legislation, and federal rules. Analyzes state legislation, federal legislation, and federal rules to evaluate its impact to MCS and stakeholders, including MCOs, service providers, and members. (25%)

Establishes, facilitates, and participates in relevant workgroups and committees, including inter-agency workgroups and committees. Coordinates and provides requested training to internal staff and external entities. (20%)

Prepares high quality written documents such as project updates, reports, PowerPoint presentations, communications to stakeholders and contractors, executive memos, policy and project summaries, legislative reports, administrative rules, waivers, and state plan amendments. (20%)

Other duties as assigned. (10%)

Knowledge, Skills and Abilities (KSAs):

Knowledge of:

• State and federal Medicaid and CHIP laws and regulations
• Complex national medical billing and coding requirements, CMS requirements, Medicare and Medicaid billing processes
• CPT, HCPCS, NCCI, and ICD medical billing and coding systems
• Government organization and administration
• Principles of health and human services policy and planning
• State of Texas legislative processes

Skills in:

• Medical billing and coding
• Analyzing, evaluating, and interpreting complex federal and state legislation, program, policy, and operations issues
• Project management policy analysis, and performing policy research
• Synthesizing, analyzing, and evaluating highly complicated and technical information
• Translating policy and technical information into easily understandable and concise documents and oral presentations.
• Developing creative and workable solutions to complex problems and policy issues
• Facilitating stakeholder and different workgroup meetings

Ability to:

• Develop, amend, and interpret program policies, rules and contract requirements related to Medicaid and CHIP Services;
• Develop and provide information to support lean business cases for information technology projects;
• Research, gather, assemble, correlate, and analyze data to devise solutions based on the information available;
• Work with a team under pressure, negotiate among multiple parties, and resolve conflicts;
• Exercise judgment and work independently with minimum supervision;
• Work cooperatively as a team member in a fast-paced, deadline-oriented environment;
• Establish and maintain effective working relationships with various levels of personnel in government entities;
• Utilize Microsoft Office Suite applications such as Outlook, Teams, Word, PowerPoint, Planner and Excel;
• Communicate effectively orally and in writing, including the ability to adjust communications to fit the intended audience; and
• Work with diverse groups of people, including stakeholders, that have a variety of opinions.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

Required

Candidate must meet one of the following:

High school diploma and at least five years of full-time work experience in a health and human services field;

Bachelor’s degree from an accredited four-year college or university and at least one year of full-time work experience in a health and human services field; or

Master’s degree from an accredited college or university in public health, public administration, public affairs, social work, or closely related field.

Candidate must also have medical billing and coding experience.

Preferred:

Work experience in developing and analyzing Medicaid policies.

Medical Billing Certification.

Additional Information:

Benefits of joining the MCS Office of Policy include:

• Leadership commitment to invest in and foster your professional growth and career advancement.
• Being part of a team that impacts the lives of millions of Texans that depend on Texas Medicaid throughout Texas.
• Being on the ground level of healthcare policy development and implementation, including the opportunity to work closely with stakeholders such as federal partners, providers, advocates, managed care organizations, and other healthcare contractors.
• Engagement with the Texas legislative process, including the opportunity to analyze and inform legislators of potential impact of proposed bills.
• The opportunity to learn and engage with multiple domains of the healthcare delivery system, including managed care, fee-for-service, federal-state Medicaid partnerships and other activities related to the administration of the Medicaid program.
• The position is located in Austin and requires regular in-office attendance.
• The final salary offer is dependent on factors such as Human Resources policies and available budget.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.